Measles, Mumps, and Rubella - Centers for Disease Control and ...
Measles, Mumps, and Rubella - Centers for Disease Control and ... Measles, Mumps, and Rubella - Centers for Disease Control and ...
46 MMWR May 22, 1998Rubella Outbreaks in Health-Care SettingsDuring rubella outbreaks in health-care settings where pregnant women may beexposed, mandatory exclusion and vaccination of health-care workers who lack evidenceof rubella immunity (Table 1) should be practiced. Exposed health-care workerswho lack evidence of immunity should be excluded from duty from the seventh dayafter first exposure through the twenty-first day after their last exposure or until 5 daysafter the rash appears. In addition, because birth before 1957 does not guarantee rubellaimmunity, health-care facilities should strongly consider recommending a doseof MMR vaccine to unvaccinated health-care workers born before 1957 who do nothave serologic evidence of immunity. Although rubella vaccination during an outbreakhas not been associated with substantial personnel absenteeism (116,191 ),vaccination of susceptible persons before an outbreak occurs is preferable becausevaccination causes far less absenteeism and disruption of routine work activities thandoes rubella infection.Mumps Case Investigation and Outbreak ControlCase DefinitionA clinical case of mumps is defined as an illness characterized by acute onset ofunilateral or bilateral tender, self-limited swelling of the parotid or other salivary glandlasting ≥2 days, and without other apparent cause (as reported by a health professional).A probable case of mumps• meets the clinical case definition of mumps, and• is not epidemiologically linked to a confirmed or probable case, and• has noncontributory or no serologic or virologic testing.A confirmed case of mumps• meets the laboratory criteria for mumps, or• meets the clinical case definition and is epidemiologically linked to a confirmedor probable case.A laboratory-confirmed case need not meet the clinical case definition. Two probablecases that are epidemiologically linked are considered confirmed, even in theabsence of laboratory confirmation.Reporting of mumps often has been based solely on clinical diagnosis withoutlaboratory confirmation. However, parotitis may have other infectious and noninfectiouscauses. Therefore, serologic confirmation of the diagnosis is preferred. Use ofcriteria for clinical diagnosis that are both stricter and more reliable, combined withlaboratory confirmation, can be expected to decrease the number of false positivemumps cases reported and allow a more accurate assessment of mumps incidence.Probable or confirmed cases of mumps should be reported immediately to stateand local health departments. Recommended procedures to enhance the comprehensivenessof reporting include identification of all contacts, follow-up of susceptiblecontacts, and serologic testing of all probable cases to confirm the diagnosis.
Vol. 47 / No. RR-8 MMWR 47Laboratory DiagnosisThe laboratory criteria for the diagnosis of mumps are• isolation of the mumps virus from a clinical specimen, or• a significant rise between acute and convalescent-phase titers in serum mumpsIgG antibody level by any standard serologic assay, or• a positive serologic test for mumps IgM antibody.In a prospective study in the practices of family practitioners in a Canadian community,one-third of persons with clinically diagnosed cases of mumps had no serologicevidence of recent mumps infection (28 ). Serum mumps IgM IFA tests are commerciallyavailable. However, until more data are available concerning the use andinterpretation of these tests, laboratory confirmation of mumps should be based ontests of demonstrated reliability. State health department laboratories can provideguidance when testing for acute mumps infection is necessary.Mumps Outbreak ControlThe strategy for outbreak control includes three main elements. The target population(transmission setting) must be defined. Persons within the population who aresusceptible to mumps must be identified and vaccinated. Consideration should begiven to excluding susceptible persons who are exempt from vaccination (for medical,religious, or other reasons) from the affected institution or setting until the outbreak isterminated. Active surveillance for mumps should be conducted until two incubationperiods (i.e., 5–6 weeks) have elapsed since onset of the last case.School-based Mumps OutbreaksExclusion of susceptible students from schools affected by a mumps outbreak (andother, unaffected schools judged by local public health authorities to be at risk fortransmission of the disease) should be considered among the means to controlmumps outbreaks. Excluded students can be readmitted immediately after they arevaccinated. Experience with outbreak control for other vaccine-preventable diseasesindicates that almost all students who are excluded from the outbreak area becausethey lack evidence of immunity quickly comply with requirements and can be readmittedto school. Pupils who have been exempted from mumps vaccination for medical,religious, or other reasons should be excluded until at least 26 days after the onset ofparotitis in the last person with mumps in the affected school.Mumps Outbreaks in Health-Care SettingsSporadic nosocomial cases of mumps have occurred in long-term care facilitieshousing adolescents and young adults (122 ). However, mumps virus is less transmissiblethan measles and other respiratory viruses. The low level of mumps transmissionin the community results in a low risk for introduction of the disease intohealth-care facilities. Because mumps is shed by infected persons before clinicalsymptoms become evident and because infected persons often remain asymptomatic,an effective routine MMR vaccination program for health-care workers is thebest approach to prevent nosocomial transmission.
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- Page 29 and 30: Vol. 47 / No. RR-8 MMWR 21SPECIAL C
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- Page 35 and 36: Vol. 47 / No. RR-8 MMWR 27are liste
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- Page 57 and 58: Vol. 47 / No. RR-8 MMWR 4927. Lee S
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46 MMWR May 22, 1998<strong>Rubella</strong> Outbreaks in Health-Care SettingsDuring rubella outbreaks in health-care settings where pregnant women may beexposed, m<strong>and</strong>atory exclusion <strong>and</strong> vaccination of health-care workers who lack evidenceof rubella immunity (Table 1) should be practiced. Exposed health-care workerswho lack evidence of immunity should be excluded from duty from the seventh dayafter first exposure through the twenty-first day after their last exposure or until 5 daysafter the rash appears. In addition, because birth be<strong>for</strong>e 1957 does not guarantee rubellaimmunity, health-care facilities should strongly consider recommending a doseof MMR vaccine to unvaccinated health-care workers born be<strong>for</strong>e 1957 who do nothave serologic evidence of immunity. Although rubella vaccination during an outbreakhas not been associated with substantial personnel absenteeism (116,191 ),vaccination of susceptible persons be<strong>for</strong>e an outbreak occurs is preferable becausevaccination causes far less absenteeism <strong>and</strong> disruption of routine work activities th<strong>and</strong>oes rubella infection.<strong>Mumps</strong> Case Investigation <strong>and</strong> Outbreak <strong>Control</strong>Case DefinitionA clinical case of mumps is defined as an illness characterized by acute onset ofunilateral or bilateral tender, self-limited swelling of the parotid or other salivary gl<strong>and</strong>lasting ≥2 days, <strong>and</strong> without other apparent cause (as reported by a health professional).A probable case of mumps• meets the clinical case definition of mumps, <strong>and</strong>• is not epidemiologically linked to a confirmed or probable case, <strong>and</strong>• has noncontributory or no serologic or virologic testing.A confirmed case of mumps• meets the laboratory criteria <strong>for</strong> mumps, or• meets the clinical case definition <strong>and</strong> is epidemiologically linked to a confirmedor probable case.A laboratory-confirmed case need not meet the clinical case definition. Two probablecases that are epidemiologically linked are considered confirmed, even in theabsence of laboratory confirmation.Reporting of mumps often has been based solely on clinical diagnosis withoutlaboratory confirmation. However, parotitis may have other infectious <strong>and</strong> noninfectiouscauses. There<strong>for</strong>e, serologic confirmation of the diagnosis is preferred. Use ofcriteria <strong>for</strong> clinical diagnosis that are both stricter <strong>and</strong> more reliable, combined withlaboratory confirmation, can be expected to decrease the number of false positivemumps cases reported <strong>and</strong> allow a more accurate assessment of mumps incidence.Probable or confirmed cases of mumps should be reported immediately to state<strong>and</strong> local health departments. Recommended procedures to enhance the comprehensivenessof reporting include identification of all contacts, follow-up of susceptiblecontacts, <strong>and</strong> serologic testing of all probable cases to confirm the diagnosis.
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